Claim edit: Payer responsibility level codes must be in order

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that skip a level in the payer responsibility sequence.

What are payer responsibility level codes?

In coordination of benefits (COB) scenarios, the patient is covered by insurance from more than one payer. The primary payer pays first, then the secondary payer, and so on.

COB claims must include information about all previous payers. Payer responsibility level codes, also called payment responsibility sequence number codes, indicate each payer’s payment order: P (primary), S (secondary), T (tertiary), then A through H for the fourth through eleventh payers.

Payer responsibility level code for the payer you’re sending the claim to

Payer responsibility level codes for the patient’s other payers

How the edit works

If a claim reports a secondary or later payer, it must also report every prior payer level before it in the order. Otherwise, the payer may reject the claim.

For example, the payer may reject a claim that reports a tertiary payer without a secondary payer.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.

Note: A responsibility level code of U (Unknown) won’t trigger this edit. A code of U doesn’t indicate a specific payment order.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Payer Responsibility Sequence. Any payer responsibility level above primary must follow the prior levels in order. The submitted payer responsibility values are out of order, P, T. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Payer Responsibility Sequence. Any payer responsibility level above primary must follow the prior levels in order. The submitted payer responsibility values are out of order, P, T. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Payer Responsibility Sequence. Any payer responsibility level above primary must follow the prior levels in order. The submitted payer responsibility values are out of order, P, T. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, and error message:

STC*A7>742*[DATE]*U*[AMOUNT]******A7>732**Invalid Payer Responsibility Sequence. Any payer responsibility level above primary must follow the prior levels in order. The submitted payer responsibility values are out of order, P, T. Correct and resubmit

STC*A7>742*[DATE]*U*[AMOUNT]******A7>732**Invalid Payer Responsibility Sequence. Any payer responsibility level above primary must follow the prior levels in order. The submitted payer responsibility values are out of order, P, T. Correct and resubmit

STC*A7>742*[DATE]*U*[AMOUNT]******A7>732**Invalid Payer Responsibility Sequence. Any payer responsibility level above primary must follow the prior levels in order. The submitted payer responsibility values are out of order, P, T. Correct and resubmit

Related claim edits

Stedi has another edit for duplicate payer responsibility level codes. See Duplicate payer responsibility level codes.

Stedi also rejects claims that don't report a primary payer. See Missing primary payer.